The Different Types of Health Insurance

There are several different types of health insurance plans designed to meet different needs. Some types of plans restrict your provider choices or encourage you to get care from the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. Others pay a greater share of costs for providers outside the plan’s network.

How are the plans different?

Health Maintenance Organization (HMO)

HMOs give you a local network of participating doctors, hospitals, and other health care professionals and facilities that you are required to choose from. These types of health insurance plans also require you to choose a primary care provider (PCP) from the network. Your PCP is your home base for medical care. They get to know you and help coordinate all your care. They will also need to provide you with a referral to see in-network specialists. The costs for an HMO plan—copays and coinsurance– are typically lower than other types of health plans, as long as you stay in-network.

HMOs usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.

What you pay:

• Premium: This is the cost you pay each month for insurance.
• Deductible: Your plan may require you to pay the amount before it covers care except for preventive care.
• Copays and/or co-insurance for each type of care. A copay is a flat fee, such as $15, that you pay when you get care. Coinsurance is when you pay a percent of the charges for care, for example 20%. These charges vary according to your plan and they are counted toward your deductible

Exclusive Provider Organization (EPO)

An EPO offers you a network of participating providers to choose from. Most EPO plans do not include coverage for out-of-network care except in the case of an emergency. This means that if you visit a provider or facility outside the plan’s local network, you will likely have to pay the full cost of services yourself.

Depending on the plan, you may or may not be required to choose a primary care provider (PCP). If you want to see a specialist in your network, you don’t need a referral from a PCP.

What you pay:

• Premium: This is the cost you pay each month for insurance.
• Deductible: Some EPOs may have a deductible.
• Copay or coinsurance: A copay is a flat fee, such as $15, that you pay when you get care. Coinsurance is when you pay a percent of the charges for care, for example 20%.
• Other costs: If you see an out-of-network provider you will have to pay the full bill.

We Accept:

• Medicare
• United Health
• Molina
• Triwest
• Private Pay

• Medicaid
• Aetna
• VA Pay
• Humana PPO
• US Family Health Plan

and many more!

Preferred Provider Organization (PPO)

PPOs typically offer you a large network of participating providers so you have a lot of doctors, hospitals, and other health care professionals and facilities to choose from. You may also choose to see providers from outside of the plan’s network, but you will pay more out-of-pocket.

Choosing a primary care provider (PCP) is not required with these types of health plans, and you can see specialists without a referral.

What you pay:

• Premium: This is the cost you pay each month for insurance.
• Deductible: Some PPOs may have a deductible. You will likely have to pay a higher deductible if you see an out-of-network doctor.
• Copay or coinsurance: A copay is a flat fee, such as $15, that you pay when you get care. Coinsurance is when you pay a percent of the charges for care, for example 20%.
• Other costs: If your out-of-network doctor charges more than others in the area do, you may have to pay the balance after your insurance pays its share.

Point of Service (POS)

Point of service plans combine features of HMO and PPO plans. The provider network is typically smaller than a PPO plan and the costs for in-network care are typically lower, like an HMO. POS plans also require you to choose a primary care provider (PCP) from within the plan’s network of doctors and other primary care professionals. Your PCP is your home base for care and advice. They get to know you and your health needs and can help coordinate all your care.

If you need to see a specialist, you are required to get a referral. However, like a PPO, you can also choose to see specialists that are in-network or out-of-network. If you see a doctor outside the plan’s network, your share of the costs will be higher and you’ll be responsible for filing any claims yourself.

What you pay:

• Premium: This is the cost you pay each month for insurance.
• Deductible: Your plan may require you to pay the amount of a deductible before it covers care beyond preventive services.You may pay a higher deductible if you see an out-of-network provider.
• Copays or coinsurance: You will pay either a copay, such as $15, when you get care or coinsurance, which is a percent of the charges for care. Copayments and coinsurance are higher when you use an out-of-network doctor.